Assomull Ravi G, Lyne Jonathan C, Keenan Niall, Gulati Ankur, Bunce Nicholas H, Davies Simon W, Pennell Dudley J, Prasad Sanjay K
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London SW3 6NP, UK.
Eur Heart J. 2007 May;28(10):1242-9. doi: 10.1093/eurheartj/ehm113. Epub 2007 May 3.
Troponin measurement is used in the assessment and risk stratification of patients presenting acutely with chest pain when the main cause of elevation is coronary artery disease. However, some patients have no coronary obstruction on angiography, leading to diagnostic uncertainty. We evaluated the incremental diagnostic value of cardiovascular magnetic resonance (CMR) in these patients.
Sixty consecutive patients (mean age 44 years, 72% male) with a troponin-positive episode of chest pain and unobstructed coronary arteries were recruited within 3 months of initial presentation. All patients underwent CMR with cine imaging, T2-weighted imaging for detection of inflammation, and late gadolinium enhancement imaging for detection of infarction/fibrosis. An identifiable basis for troponin elevation was established in 65% of patients. The commonest underlying cause was myocarditis (50%), followed by myocardial infarction (11.6%) and cardiomyopathy (3.4%). In the 35% of patients where no clear diagnosis was identified by CMR, significant myocardial infarction/fibrosis was excluded.
CMR is a valuable adjunct to conventional investigations in a diagnostically challenging and important group of patients with troponin-positive chest pain and unobstructed coronary arteries.
当肌钙蛋白升高的主要原因是冠状动脉疾病时，肌钙蛋白检测用于急性胸痛患者的评估和风险分层。然而，一些患者血管造影显示无冠状动脉阻塞，导致诊断存在不确定性。我们评估了心血管磁共振成像（CMR）在这些患者中的增量诊断价值。
连续纳入60例患者（平均年龄44岁，72%为男性），这些患者在首次出现胸痛后3个月内肌钙蛋白检测呈阳性且冠状动脉无阻塞。所有患者均接受了CMR检查，包括电影成像、用于检测炎症的T2加权成像以及用于检测梗死/纤维化的钆延迟增强成像。65%的患者确定了肌钙蛋白升高的可识别原因。最常见的潜在病因是心肌炎（50%），其次是心肌梗死（11.6%）和心肌病（3.4%）。在CMR未明确诊断的35%患者中，排除了显著的心肌梗死/纤维化。
对于肌钙蛋白阳性且冠状动脉无阻塞、诊断具有挑战性且重要的患者群体，CMR是传统检查的一项有价值的辅助手段。
